First Colombian consensus on congenital Chagas and clinical approach for women of child-bearing age diagnosed with Chagas / Primer consenso colombiano sobre Chagas congénito y orientación clínica a mujeres en edad fértil con diagnóstico de Chagas

Congenital transmission of Chagas disease has not been extensively studied in Colombia, and there are no standardized processes in the health system regarding the specific diagnosis, treatment and follow-up of this disease. To generate recommendations on congenital Chagas disease and Chagas in women of childbearing age in Colombia, a consensus of experts was developed. An extensive literature search through the Medline database was carried out using the MeSH terms: «Chagas disease/congenital¼, «prevention and control¼, «diagnosis¼, «therapeutics¼ and «pregnancy¼. Appropriate abstracts were selected and the full texts were analyzed. The relevant information was synthesized, classified, and organized into tables and figures and was presented to a panel of experts, which was composed of 30 professionals from various fields. Based on the Delphi methodology, three rounds of consultation were conducted. The first and second rounds were based on electronic questionnaires that measured the level of consensus of each question among the participants. The third round was based on a face-to-face discussion focusing on those questions without consensus in the previous consultations. The evidence was adapted to national circumstances on a case-by-case basis, and the content the final document was approved. These recommendations are proposed for use in routine medical practice by health professionals in Colombia.

La transmisión congénita de la enfermedad de Chagas ha sido poco estudiada en Colombia y existen pocos procedimientos rutinarios en el sistema de salud para el manejo de esta enfermedad. Por ello se desarrolló un consenso de expertos dirigido a generar recomendaciones de diagnóstico y tratamiento de Chagas con- génito y orientación a mujeres en edad fértil. Con ese propósito se realizó una búsqueda extensiva de la literatura, empleando una combinación de términos Mes (Chagas, Chagas congénito, prevención, control, diagnóstico, tratamiento y embarazo) para reflejar el estado del arte en cada tema de interés. Después de ello, se leyeron los resúmenes y aquellos seleccionados para análisis del texto completo. La literatura relevante se sintetizo, clasifico y organizo en tablas y se presentó al panel de expertos, el cual estaba constituido por 30 profesionales en diferentes áreas. Mediante la metodología Delphi se realizaron 2 rondas de cuestionarios virtuales y una reunión presencial en los cuales se evaluaron los niveles de acuerdo entre los participantes. Los puntos con falta de consenso durante las 2 rondas virtuales se expusieron durante las mesas de discusión en la ronda presencial. La evidencia utilizada se adaptó a las particularidades nacionales según el caso y se aprobó el contenido del documento final. Se propone que estas recomendaciones sean usadas por profesionales de la salud en Colombia.

Relative performance of the two hands in simple and choice reaction time tasks

There is evidence that the left hemisphere is more competent for motor control than the right hemisphere. This study investigated whether this hemispheric asymmetry is expressed in the latency/duration of sequential responses performed by the left and/or right hands. Thirty-two right-handed young adults (16 males, 16 females; 18-25 years old) were tested in a simple or choice reaction time task. They responded to a left and/or right visual target by moving their left and/or right middle fingers between two keys on each side of the midline. Right hand reaction time did not differ from left hand reaction time. Submovement times were longer for the right hand than the left hand when the response was bilateral. Pause times were shorter for the right hand than the left hand, both when the responses were unilateral or bilateral. Reaction time results indicate that the putatively more efficient response preparation by the left hemisphere motor mechanisms is not expressed behaviorally. Submovement time and pause time results indicate that the putatively more efficient response execution by the left hemisphere motor mechanisms is expressed behaviorally. In the case of the submovements, the less efficient motor control of the left hand would be compensated by a more intense attention to this hand.

Comportamento visual e perfil socioeconômico e demográfico de recém-nascidos prematuros da Maternidade do Hospital das Clínicas de Pernambuco - UFPE / Visual behavior and socioeconomic and demographic profile of the premature newborns from Federal University of Pernambuco Maternity (UFPE)

OBJETIVO: Caracterizar o comportamento visual e perfil socioeconômico e demográfico de recém-nascidos prematuros no primeiro mês de idade cronológica. MÉTODOS: Estudo descritivo de corte transversal, aninhado a um estudo longitudinal intitulado: "Comparação do comportamento visual no primeiro trimestre de vida de lactentes nascidos pré-termo em duas maternidades da cidade do Recife/PE". A amostra foi composta por 52 recém-nascidos prematuros recrutados de junho de 2007 a junho de 2008, na Maternidade do Hospital das Clínicas da Universidade Federal de Pernambuco. Foram coletados dados biológicos, socioeconômicos e demográficos dos recém-nascidos e famílias, por meio de consulta aos prontuários e entrevista com as genitoras. Para caracterizar o comportamento visual dos recém-nascidos utilizou-se o Método de Avaliação do Comportamento Visual de Lactentes. RESULTADOS: Observou-se que a maioria dos recém-nascidos era do sexo masculino, com idade gestacional entre 33 semanas e 36 semanas e 6 dias, apresentaram comportamento visuomotor adequado para a faixa etária pesquisada e que a maioria das famílias apresentava boas condições socioeconômicas e demográficas. Ainda foi possível detectar em 19 por cento da amostra sinais oculares, os quais foram encaminhados para um Serviço de Oftalmologia. CONCLUSÕES: Os resultados apontam o método como um instrumento importante na triagem visual, possibilitando a detecção oportuna de alterações visuais em lactentes prematuros desde o 1º mês de vida. O olhar clínico da avaliação terapêutica ocupacional de lactentes deve voltar-se para a observação do comportamento considerando não apenas os riscos biológicos, mas também a influência que os fatores ambientais e sociais exercem sobre o desempenho funcional da criança.

OBJECTIVE: To characterize the behavior of premature newborns in the first year of chronological age. METHODS: This is a cross-sectional descriptive study, bound to a longitudinal study titled: "Comparison of visual behavior on the first quarter of year of life of premature nursling born at two maternities of Recife/PE." The sample was composed by 52 premature newborns selected from June, 2007 to June, 2008 from the Maternity of the Federal University of Pernambuco (UFPE). Biological, socioeconomic and demographic data was collected through medical records and interviews with progeny. Newborns were evaluated by the Assessment Guide of Visual Ability in Infants. RESULTS: Most of the newborns were male at a gestational period between 33 weeks and 36 weeks and 6 days, showed a good visual behavior development for the age researched, and most of the families showed good socioeconomical and demographic profile. Besides, it was possible to detect ocular signs in 19 percent of sample, that were referred to an Ophthalmology Service. CONCLUSION: This study results point out the method like an important key in the early detection and visual screening for premature nursling since the first month of life and it led us to believe that clinical view for occupational therapy intervention must be focused not only on biological risks but also at the influence environment in newborn performance.

The Influence of Contrasts on Directional and Spatial Frequency Tuning in Visual Cortex Areas 17/18 of the Cat

PURPOSE: The purpose of this study was to investigate the effects of contrast display exposure on neuronal directional and spatial frequency tuning. Neuronal responses were recorded from ninety-four neurons in cortical areas 17 and 18 in two adult cats. METHODS: A multi-channel microelectrode was implanted in cortical areas 17 and 18 of two paralyzed and anaesthetized cats. Various drifting sinusoidal grating contrast displays were presented to one of the cats' eyes in the visual field. Contour plots based on the neuronal responses to the drifting sinusoidal grating displays using various contrasts (i.e., 0.4, 0.7, and 1.0) and velocities (i.e., 4.6, 13.9, 23.1, 32.3, 41.5, 50.8, and 60.0 deg/sec) were plotted as a function of the spatial frequency and the direction associated with each velocity and contrast used. RESULTS: Five parameters were extracted from these contour plots: 1) optimum response, 2) preferred direction, 3) optimum spatial frequency, 4) directional tuning width, and 5) spatial frequency bandwidth. To determine the optimal velocity, each parameter was plotted against each of the specific display contrasts used, and a 'best fit' line was established. Response amplitudes were dependent on the type of contrast utilized; however, the spatial frequency and directional tuning properties were stable for the cortical neurons assessed. CONCLUSIONS: The results of the presentation of different contrasts on neuronal directional and spatial frequency tuning are consistent with behavioral results when medium and high contrast displays are used.

Lateral asymmetry of voluntary attention orienting

We recently demonstrated that automatic attention favors the right side of space and, in the present study, we investigated whether voluntary attention also favors this side. Six reaction time experiments were conducted. In each experiment, 12 new 18-25-year-old male right-handed individuals were tested. In Experiments 1, 2, 3 (a, b) and 4 (a, b), tasks with increasing attentional demands were used. In Experiments 1, 2, 3a, and 4a, attention was oriented to one or both sides by means of a central spatially informative visual cue. A left or right side visual target appeared 100, 300, or 500 ms later. Attentional effects were observed in the four experiments. In Experiments 2, 3a and 4a, these effects were greater when the cue indicated the right side than when it indicated the left side (respectively: 16 ± 10 and 44 ± 6 ms, P = 0.015, for stimulus onset asynchrony of 500 ms in Experiment 2; 38 ± 10 and 70 ± 7 ms, P = 0.011, for Experiment 3a, and 23 ± 11 and 61 ± 10 ms, P = 0.009, for Experiment 4a). In Experiments 3b and 4b, the central cue pointed to both sides and was said to be non-relevant for task performance. In these experiments right and left reaction times did not differ. The most conservative interpretation of the present findings is that voluntary attention orienting favors the right side of space, particularly when a difficult task has to be performed.

Topographical disorientation in Alzheimer's disease / Desorientação topográfica na doença de Alzheimer

Topographical disorientation (TD) has not been as extensively studied as other frequent manifestations of Alzheimer's disease (AD). OBJECTIVE: To verify the occurrence of TD and to identify the neuropsychological dysfunctions associated with TD in AD. METHOD: Thirty patients with probable AD, their caregivers and 30 subjects without dementia (controls) were interviewed with a questionnaire and evaluated with tests related to topographical orientation. RESULTS: AD patients, even those with mild dementia, differ from controls in the questionnaire on topographical orientation and in most neuropsychological tests except for tests of spatial working memory, point localization, three dimension and nonsense figure copy. When the performances in the neuropsychological tests of patients with mild or moderate dementia were compared, only landmark recognition and route description were more impaired in moderate dementia. CONCLUSION: TD occurs even in mild dementia of AD, a finding apparently not explained by the impairments of more elementary spatial functions.

Desorientação topográfica (DT) não tem sido tão exaustivamente estudada quanto outros sintomas frequentes da doença de Alzheimer (DA). OBJETIVO: Verificar a ocorrência de DT e identificar as disfunções neuropsicológicas associadas com a DT na DA. Método: Trinta pacientes com DA provável, seus cuidadores e trinta sujeitos sem demência (controles) foram entrevistados com um questionário e testes relacionados à orientação topográfica. RESULTADOS: Pacientes com DA, mesmo aqueles com demência leve, diferiram dos controles no questionário de orientação topográfica e na maioria dos testes neuropsicológicos, exceto nos testes memória operacional espacial, localização de pontos, cópia de figuras sem sentido e de figura em três dimensões. Quando os desempenhos de pacientes com demência leve ou moderada foram comparados, apenas os testes de reconhecimento de marcos e descrição de rotas foram mais comprometidos na demência moderada. CONCLUSÃO: DT ocorre mesmo na demência leve da DA, um achado aparentemente não explicado pelo comprometimento das funções espaciais mais elementares.

The anteromedial extrastriate complex is critical for the use of allocentric visual cues and in the retention of the Lashley III maze task in rats

The anteromedial extrastriate complex has been proposed to play an essential role in a spatial orientation system in rats. To gain more information about that possible role, in the present work, two questions were addressed: 1. Are allocentric visual cues relevant for acquisition of the orientation task in the Lashley III maze? 2. Is this integration of allocentric inputs in the anteromedial visual complex relevant in the retention of this test? While a control group of rats was trained keeping the maze in the same position, the experimental group was trained with the maze rotated counterclockwise by 144 degrees from session to session. Control rats reached learning criterion significantly earlier and with less errors than the experimental ones (p<.05). After 11 sessions, rats of both groups received stereotaxic injections of ibotenic acid in the anteromedial complex. In the retention test one week after surgery, the control group, which had been able to learn using egocentric and allocentric visual cues, showed a greater deficit than the experimental animals (p<.05). These results confirm the role of the anteromedial complex in the processing of visuospatial orientation tasks and demonstrate the integration of allocentric visual cues in the solution of those tasks.

EEG spectral cohrence inter and intrahemispheric during catching object fall task

The aim of the present study was to evaluate coherence measures at Theta through qEEG during the accomplishment of a specific motor task. The sample consisted of 23 healthy individuals, both sexes, with ages varying between 25 and 40 years old. All subjects were submmitted to a specific motor task of cacthing sequences of falling balls. A three-way ANOVA was employed for the statistical analysis, which demonstrated main effects for the following factors: time, block and position. However, there was no interection between the factors. A significant and generalized coherence reduction was observed during the task execution time. Coherence was also diminished at the left frontal cortex and contralateral hemisphere of the utilizing limb (comparing to the right frontal cortex). In conclusion, these findings suggest a certain specialization of the neural circuit, also according to previous investigations. The inter-coherence reduction suggests a spatial inter-electrode dependence during the task, rather than a neuronal specialization.

O objetivo do presente experimento foi avaliar medidas de coerência na banda Teta através do EEGq durante a realização de uma atividade motora. A amostra constituiu-se de 23 sujeitos saudáveis, ambos os sexos, faixa etária entre 25 e 40 anos. Os sujeitos foram submetidos à tarefa motora de apreensão seqüencial de bolas em queda livre. Para análise estatística foi realizada uma ANOVA (Three-Way) que demonstrou efeito principal para os fatores: momento, tempo e posição. Porém não houve interação entre os fatores. Uma diminuição generalizada significativa da coerência ocorreu ao longo do tempo de execução da tarefa que também se apresentou reduzida no córtex frontal esquerdo, hemisfério contralateral ao membro utilizado (em comparação com o córtex frontal direito). Em conclusão, estes achados sugerem especialização do circuito neural que estão em consonância com experimentos prévios. A diminuição da coerência inter-hemisférica sugere uma dependência espacial inter-eletrodos durante a tarefa e não uma especialização neuronal.

Early-life nutritional environment and spatial navigation in the water shrew, Sorex palustris (Insectivora).

Studies were conducted to study the effects of early-life nutritional environment on spatial navigation ability in the water shrew (Sorex palustris), as well as to provide information on life history traits and husbandry. The mean longevity of males and females in captivity was 652.3 +/- 33.8 SD and 616.2 +/- 22.5 days, respectively. Litter sizes ranged from 5 to 8 and neonatal mass ranged from 0.71 to 0.83 g. Spatial navigation was examined by use of the Morris water apparatus, where animals were required to locate the position of an escape platform in a circular tank of water. The platform was visible (proximal cue version of the task) in some tests. In other tests it was hidden beneath the surface (distal cue version) by making the water opaque using a non-toxic white dye. The tank was divided into 4 quadrants and the position of the plafform in any quadrant could be fixed for any subject or varied between subjects. Early-life under-nutrition was achieved by maintaining some shrews on a restricted diet (received half the amount of food as did controls). Under-nutrition was found to have an adverse effect on spatial navigation. Regardless of nutritional status, shrews were able to locate a hidden plafform that was placed at the center of a given quadrant more rapidly (escape latency) when it was visible (44 to 69 sec) than when it was hidden (83 to 164 sec). Results also showed that these shrews utilize both proximal and distal cues in this spatial task. Control subjects spent more time at a location where the platform had been in a previous test (69% of the trial period) than their undernourished counterparts (45 to 51%). This is the first experimental analysis of spatial navigation and the effects of early-life under-nutrition on this task, for S. palustris.

Avaliação e tratamento fisioterapêutico das alterações motoras presentes em crianças deficientes visuais / Evaluation and physiotherapy treatment of motor alterations on visual deficients children

Neste trabalho se propôs verificar as principais alterações motoras e de desenvolvimento presentes em portador de deficiência visual objetivando assim um atendimento fisioterapêutico adeuqado com as características individuais e sua faixa etária. Universidade de Santo Amaro, Faculdade de Fisioterapia - Serviço de Reabilitação ao portador de deficiência visual/ Rua Professor Enéas de Siqueira Neto, 340 - cep 04849-300, Jardim das Imbuias - São Paulo/ SP, Prédio C1. Foram avaliados neste estudo, 12 (doze) crianças portadores de cegueira ou de visão subnormal congênita, que deambulavam de forma independente. Após caracterizados seus principais distúrbios relacionados a suas respostas motoras, estes pacientes foram submetidos, no período de vinte meses compreendido entre março de 2002 e dezembro de 2003, a um protocolo de tratamento fisioterapêutico. As terapias eram individualizadas, uma por semana, com duração de uma hora. Os déficits motores foram identificados. De maneira geral, os portadores de deficiência visual participantes dessa pesquisa apresentaram grande melhoria em seu quadro geral. Verificou-e Reações de Proteção mais efetivamente desencadeadas, equilíbrio com melhora de 14 por cento. O processo de avaliação foi diferenciado de acordo com a faixa etária do paciente em atendimento. A deficiência visual tem como característica desenvolver alterações na criança, interferindo assim no seu controle e desenvolvimento motor. Verifcou-se que os prejuízos que essas alterações trazem ao deficiente visual podem ser minimizados através de programas terapêuticos adequados, recuperando seu controle motor através das experiências sensoriais que podem ser oferecidas à criança enfatizando seu desenvolvimento

Atención: la compuerta a la conciencia / Attention: the gate to consciousness

La atención es un proceso cognositivo de alto orden cuyo déficit modifica de manera importante las estrategias adaptativas del individuo en el aspecto intelectual, social y emocinal. El conocimiento de los mecanismos que subyacen a la selección y procesamiento de los estímulos ambientales, podría explicar algunas manifestaciones clínicas que se observan en algunos padecimientos neuropsiquiátricos. La atención es un proceso que es difícil definir en términos conceptuales e incluso operacionales. Sin embargo, se han propuesto diversas teorías para explicar dicho proceso. La mayoría de ellas coinciden en que los individuos tienen una capacidad limitada para analizar los estímulos del medio, por lo que en algún momento los estímulos poco relevantes se deben filtrar. La ubicación de dicho filtro en el sistema nervioso es aún tema de debate ya que es difícil ubicar anatómicamente este filtro a nivel periférico o central. En el presente trabajo se hace una revisión crítica de la bibliografía relevante acerca de las teorías que apoyan una u otra visión; asimismo, se presenta una panorámica general de los avances en los estudios conductuales y electrofisiológicos que subyacen el proceso de atención

El examen mental / Mental examination

El examen mental abarca una serie de ítemes, muchos de los cuales pueden ser aplicados por el médico general para la evaluación del estado mental de un determinado paciente. Se hace una descripción suscinta de los diferentes estados de conciencia, desde la lucidez hasta el coma, con las características distintivas de cada uno. Se dan algunos ejemplos de preguntas que sirven para determinar la orientación, la atención, la memoria y el juicio. Se define el Coeficiente Intelectual (CI) y la forma de calcularlo, dividiendo la edad mental por la edad cronológica. Se expone una tabla sobre puntaje de coeficiente intelectual y sus denominaciones. Se hacen consideraciones sobre la inteligencia; se definen los diferentes grados de déficit intelectual u oligofrenia; como así mismo sobre el deterioro mental fisiológico y patológico hasta la demencia. Se exponen una serie de preguntas -problemas que hacen reflexionar sobre pensamiento abstracto, significado de proverbios, ideas de conjunto, cálculo e información general. Todo ello podrá servir al clínico para la apreciación, o una aproximación, de la capacidad intelectual de una persona o sospechar un deterioro

Interaction between facilitatory and inhibitory effects due to voluntary and automatic covert orienting of attention

Covert orienting of attention to one spatial location improves the processing of signals occurring at this location at the expenses of the processing of signals occurring at other spatial positions. According to the premotor theory of visual attention, the voluntary orienting of attention to a peripheral position corresponds to the programming of a saccadic eye movement towards this position. A similar mechanism has been proposed to explain the inhibitory effects elicited by a non-informative peripheral cue. This review discusses some neural mechanisms involved in the facilitatory and inhibitory effects due to covert orienting of attention.

Backup compass mechanisms in pigeon orientation with the sun in the zenith

The sun is known to guide homing pigeons as a priority cue. The literature indicates that under total overcast conditions pigeons rely on a backup mechanism akin to the magnetic inclination compass for which there is much laboratory evidence in migratory birds. Total overcast conditions are not favorable for orientation research in the State of Sao Paulo, Brazil. The orientation of homing pigeons raised near the tropic of Capricorn was therefore observed around the time of the December solstice, when the sun culminates directly overhead, with a consequent interruption of the sun compass for a short time every day. In these experiments, carried out between 1981 and 1993, local geomagnetic field inclination was -25 degrees Celsius to -29 degrees Celsius 30', so that a functioning magnetic inclination compass should have been available to the birds. Whereas the birds released with sun to zenith angles between 10 degrees Celsius and 30 degrees Celsius were well oriented, both in the morning (99 vanishing bearings) and in the afternoon (143 vanishing bearings), those released with the sun less than 5 degrees Celsius away from the zenith showed random orientation (105 vanishing bearings), with no evidence of an alternative magnetic compass mechanism.

Cat striate cortex: monocular and interocular comparisons of spatial-frequency selectivity

Spatial frequency and bandwith characteristics were determined for neurones in cat striate cortex. Responses to drifting sin-wave gratings, optimized for orientation, direction and velocity, were determined over a range of spatial frequencies. Comparative measurements of spatial frequency tuning at constant velocity and at constant temporal drift frequency revealed that, overall, tuning derived by either method was similar. Results were evaluated in relation to neuronal class (simple or complex); cell subclass (standard, intermediate or special), defined by length summation, directionality; and velocity selectivity. Distributions of optimal spatial frequency for simple and complex neurones were comparable. By contrast, bandwidths of simple neurones were markedly narrower than for complex neurones, Standard complex neurones, in turn, had narrower vandwidths than special or intermediate complex neurones. Optimal spaties frequency correlated inversely with optimal velocity, directly with orientation selectivity. Thus, neurones tuned to high spatial frequencies tended to respond optimally to low velocities, and were more sharply orientation selective, than neurones tuned to low spatial frequencies. In binocular nurones, spatial frequency tuning characteristics of the two monocular imputs were compared. For either eye, spatial frequency tuning curves were reproducible over time. In a minority of neurones, spatial frequency characteristics were matched for the two eyes . A Majority showed mismatch in spatial frequency characteristics between the eyes. Individual neurones were tuned to different bands of spatial frequencies through either eye; more sharply spatial-frequency selective through one eye than the other; or had both dissimilar bandwidth and spatial frequency. Changing imput spatial-frequency resulted in profound, systematic shifts in ocular dominance. These were progressive in the case of spatial-frequncy mismatch. In cases of bandwidth, or bandwidth an spatial-frequency mismatch, the eye associated with more sharply-tuned imput exerted relatively greater influence at centre frequencies, the other eye relatively greater influence at extreme frequencies...

Accessory optic-pretectal interactions in the pigeon

This electrophysiological study analyzes the influence of the nucleus of the basal optic root (nBOR) of the avian accessory optic sustem on units within the lentiform nucleus (LM), which is the avian equivalent of the pretectal nucleus of the optic trat. A prominent depression of the spontaneous firing rat of neurons within the LM occurred following electrical stimulation of the ipsilateral nBOR. A close correlation was also found between the directional selectivity of LM units and the apparent displacements generated by rotations of the head around the horizontal semicircular canal axis. This is consistent with a possible rolo of the LM in the coordinate transformation from visual imputs to a vestibular referense system

Angiotensin II antiserum decreases luteinizing hormone-releasing hormone in the median eminence and preoptic aea of the rat

Ovariectomized female rats were sacrificed 3 h after intracerebroventricular microijnjection of normal rabbit serum (NRS), specific antiserum against angiotensin II (AB-AII) or atrial natriuretic factor (AB-ANF). AB-AII decreased plasma LH by 50% and LH-RH content by 70% in the median eminence and medial preoptic area, respectively, but did not change plasma FSH when compared to animals which receivede NRS. There was no difference in these parameters when the animals were injected with AB-ANF or NRS.These results indicate that endogenous AII plays a physiological role in LH release acting directly or indirectly through LH-RH neurons of the median eminence and medial peroptic area